BBL: can fat be injected into muscle?

Dear Sincere8600,
In case of BBL surgery, most plastic surgeons inject fat above the muscle in order to avoid serious complications such as pulmonary embolism. Fat viability depends a lot of surgeon technique. The fat has to be placed back into the buttocks as soon as possible so that it has a greater chance of survival. It has to be placed carefully so that not too much fat is placed in only one area. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thanks for your question. With Brazilian butt lift we transfer fat from one area of the body to the other.  These fat cells are transferred in microinjections throughout multiple planes in the buttock tissue so that they can gain new blood supply and live in their new home, providing increased volume and shape to the buttocks.  You definitely have to choose your surgeon correctly and make sure that he/she has the training and experience to meet your goals with absolute safety.  Best is a Board Certified Plastic Surgeon with specialized expertise in this procedure.

Hello and thank you for your question. Fat injection into the muscle should be avoided due to concerns about fat embolism as you mentioned. I would refer you to the most recent guideline issued by the American Society for Aesthetic Plastic Surgery (Just google for BBL safety ASAPS),Best,Pejman Aflaki, M.D.

Johns Hopkins-trained double board-certified plastic surgeon

For over 20 years, the BBL was taught to young surgeons as a method to improve the body contours and to augment hip and buttock projection by liposuctioning unwanted areas of fat and transferring that fat to the buttocks and hips. The transfer of fat to the muscle layer was preferred as the vascularity of the muscle was better and allowed for better fat graft viability or take.  Safety is always number one for patients, but there are admittedly times when science gets ahead of itself. I recognized the problem with injecting fat into the muscle several years ago and altered my technique accordingly. The fat is injected above the gluteus muscles and superficially under the skin into the fat and surrounding tissue of the buttocks.  I do NOT inject fat into the muscle to all but eliminate the risk for fat embolus and death.

Hello dear!
Thanks for the question and provided information as well.
Injecting fat under the muscle is dangerous and carries many health risks. This is why no doctor should incur in this practice.
l recommend you to make an appointment with a board certified plastic surgeon to talk about your goals and anything you need to know.
Good luck :)
 

 And there is spin and there is real information. Just like there's fake news and real news.  Plastic surgery unfortunately seems to have fallen into the main stream where there is perpetual twisted information being disseminated by those trying to promote their practices.  A BBL is not a micro fat transfer procedure by any means. The volumes used or macro in every way.  There is no definition of what is called micro or macro anything in plastic surgery so this is all spin to make some and attempt to appear superior with their technique.  Generally large cannula's " very macro " should be used to transfer the fat to minimize a fat embolism. Minimum of 5 mm.  These are really big cannula's but have shown or it is believed that they decrease the chance of a fat embolism.  This is a very hot topic and has a fair amount of controversy. Some plastic surgeons have definitively given up on injecting fat in the gluteus muscle for safety reasons while others do it to a certain degree.  Plastic surgeons may also inadvertently inject fat in the muscle without realizing it because this is a blind procedure.  Personally I believe this the stated rate of a fat embolism occurring one in 3000 BBL's is overstated if care is taken during the procedure.  I personally believe the greatest safety factor for minimizing a fat embolism is the use of high concentration epinephrine tumescent solution into the gluteal region 20 minutes before the fat transfer is done.  The vasoconstrictive effects of epinephrine minimize damage to blood vessels more than anything else during surgery.  There's no research to support my claim in regards to fat transfer but all plastic surgeons know how much less blood vessel damage we have during surgical procedures including liposuction when sufficient amounts of epinephrine are used.  I do liposuction and fat transfer procedures with my patients awake. Because of this large amounts of numbing solution Hass to be injected well in advance.  Personally, I believe this is the greatest safety variable you can add to the procedure.  It is wise to have a discussion with your plastic surgeon in regards to how and where they plan to inject fat.  It's also important to understand why there is a temptation to inject fat in the gluteus muscle.  The bottom line, the amount of fat that will survive long-term goes up greatly when we have more tissue to inject fat into especially highly vascular tissue like muscle.  Injecting fat in the gluteus muscle as well as more superficial layers gives the most dramatic results.  The pressure from patients to deliver impressive results that border on excessive is immense and patient scrutinize doctors more on their results than anything else.  It's simply a trade off on how much fat you want to survive versus risk.  Nothing else really matters. The equipment used or specific technique or processing of the fat are all irrelevant.  The most important and really the only decision you should focus on is who does the procedure.  In this case it includes the plastic surgeons commitment to safety which should be discussed in person.  I do not take a personal stance that injecting fat in the gluteus muscle is appropriate or not. I believe taking all other safety precautions possible first and foremost are an obligation and nonnegotiable.  Using gentle surgical technique, large cannula's, the use of epinephrine as described above etc. should always be done.  I do not recommend traveling for elective surgical procedures.  Patients do not appreciate the importance of proper follow-up care, the complications actually do happen as well as how many people end up needing revisions.  Yesterday we saw three patients who flew to Miami to have BBL surgery and are now needing revisions.  Nothing wrong with Miami. The point is these things are far more important than patience appreciate.  Have in person consultations with local board-certified plastic surgeons who have experience with this procedure.  Best, Mats Hagstrom MD 

Both the American Society of Plastic Surgery (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) strongly recommend against injecting fat into or deep to the Gluteal muscles, when performing BBL procedures  Studies have shown that injecting fat into these deeper tissue planes carry a significantly higher risk of intravascular fat injection and subsequent pulmonary fat emboli, which can be life threatening.  Both the ASPS and ASAPS advises that fat should only be injected in the subcutaneous fat plane in the buttock, in order to reduce the risk of fat emboli.  Best wishes, Dr. Lepore.